Effectiveness of clinical pharmacist intervention on smoking secession

Sattanathan.K et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-2(4) 2014 [372-388]

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IJAMSCR |Volume 2 | Issue 4 | Oct-Dec- 2014

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Research article Health research

Effectiveness of clinical pharmacist intervention on smoking secession Beula.V, Sattanathan.K*, Sambathkumar.R.

Department of Pharmacy Practice, JKK Nattraja College of Pharmacy, Kumarapalayam, Namakkal-DT.,

India.

* Corresponding author: Sattanathan.K

E-mail id: [email protected]

ABSTRACT

This work was carried out in a tertiary-care hospital at Calicut,kerala The patients under study will be included, males,

children and even females aging between 17 – 75 years with lungs disease, hypertension, coronary artery disease, Asthma,

carcinoma and allergic complaints. The study evaluated the effectiveness of a hospital initiated smoking cessation

intervention by a clinical pharmacist that included 3 months of follow up and also analyzed the baseline demographics of

smokers. The pharmacist-managed Smoking Cessation program successfully aided approximately more than half its

participants to quit smoking at 1 and 3 months. Although higher attendance rates increase cessation rates, steps could be

taken in order to effectively maximize the pharmacist’s time and minimize patient commitment, while also achieving the best

patient outcomes. The most common reasons for quitting smoking were a concern with the current health status and a

concern with the future health status.

Key Words: Smoking secession, Tobacco, Drug addiction, Drug abuse.

INTRODUCTION

Drug Addiction and Drug Abuse:

It is the chronic or habitual use of any chemical substance

to alter states of body or mind for other than medically

warranted purposes. The United States has the highest

substance abuse rate of any industrialized nation.

Marijuana is the most commonly used illicit drug. Legal

substances, approved by law for sale over the counter or

by doctor's prescription, include caffeine, alcoholic

beverages, nicotine, and inhalants (nail polish, glue,

inhalers, gasoline). People take drugs for many reasons:

peer pressure, relief of stress, increased energy, to relax,

to relieve pain, to escape reality, to feel more self-esteem,

and for recreation. They may take stimulants to keep alert,

or cocaine for the feeling of excitement it produces.

Tobacco use

Tobacco may be smoked (in the form of cigarettes,

beedis), chewed (as gutka, khaini, etc) and inhaled as

snuff.India is among the world’s largest tobacco

consuming societies. Tobacco usage in India is also

contrary to world trends since chewing tobacco and the

bidi are the dominant forms of tobacco consumption,

whereas internationally the cigarette is the most

prominent form of tobacco use. About 19% of tobacco

consumption in India is in the form of cigarettes, while

53% is smoked as bidis; the rest is used mainly in

smokeless form. Bidi’s tend to be smoked by lower

economic classes and have a level of social acceptance in

different cultures. Cigarettes and other forms of tobacco

are addictive because of the presence of nicotine. Nicotine

International Journal of Allied Medical Sciences

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Sattanathan.K, et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-2(4) 2014 [372-388]

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373

blood levels achieved by smokeless tobacco use are

similar to those from cigarette smoking.Tobacco smoke

contains 4,000 different constituents, including toxic

substances such as carcinogens (N-nitroso amines,

aromatic hydrocarbons), ammonia, nitrogen oxide,

hydrogen cyanide, CO and nicotine.Nicotine is the main

component in cigarettes that contributes to addiction,

although psychological factors and habituation also play a

role. Nicotine acts on specific nicotinic acetylcholine

receptors in the brain, stimulating the release of dopamine

that is believed to be associated with the acute rewarding

effect of nicotine.

“Bidis” or “beedis” are slim, hand-rolled, unfiltered

cigarettes. A bidi consists of about 0.2 gram of sun-dried

and processed tobacco flakes, rolled in a tendu leaf

(Diospyroselanoxylon) or temburni leaf and held together

by a cotton thread. The tobacco rolled in bidis is different

from that used in cigarettes and is referred to as bidi

tobacco.One study found that bidis produced

approximately three times the amount of carbon

monoxideand nicotine and approximately five times the

amount of tar as cigarettes. Thus bidis are known as the

“poor man’s cigarettes”, as they are smaller and cheaper

than cigarettes.

Definition of tobacco dependence:

Tobacco dependence can be defined ‘‘as a cluster of

behavioral, cognitive and physiological phenomena that

develop after repeated use and typically include a strong

desire to smoke, difficulty in controlling its use, persisting

in its use despite harmful consequences, increased

tolerance to nicotine, and a (physical) withdrawal state.’’

The World Health Organization (WHO) International

Classification of Diseases 10 (ICD-10) classifies tobacco

smoking under ‘‘Mental and behavioral disorders” as F17,

mental and behavioraldisorders due to use of tobacco.

Objectives

To analyze the baseline characteristics of smokers.

To identify contributing factors of smokingamong

subjects.

To evaluate the effectiveness of clinical pharmacist’s

intervention in the program by comparing

a. Cessation outcomes in test and control using

follow up questionnaire

b. The quit rates in both groups.

c. Percentage of smokers who reduced cigarette

number in both groups.

d. Degree of awareness of health dangers of

smoking in both groups and

e. By administering a survey questionnaire on the

test group.

f. To prepare guidelines on smoking cessation.

Methodology:

Study Design and Setting

This work was carried out in a tertiary-care hospital at

Calicut,kerala

Ethical Consideration

The ethical committee in the institution approved the

study process. The ethical committee got provided with

the reports and the progress.

Identification of eligible patients

The patients under study will be included, males, children

and even females aging between 17 – 75 years with lungs

disease, hypertension, coronary artery disease, Asthma,

carcinoma and allergic complaints.

Eligibility

1. Lungs disease patient

2. Carcinoma patient

3. Asthma patients

4. Peripheral vascular disease patient

5. Addicative patients

Methodology

Taking complete report from hospital about the patients

who are suffering from lungs disease, asthma, pulmonary

embolism, carcinoma and allergic conditions.

In the present study the sample comprised 80 subjects

who were interviewed in person. The subjects were

divided into test and control with a sample size of 40 in

each group. There were no significant differences in any

of the baseline demographic or medical characteristics of

participants in the 2 study arms.

The data analysis of the two populations is divided in to

two groups. First, the baseline demographic

characteristics of smokers and contributing factors for

smoking are analyzed. Secondly the main aim of the study

which is the evaluation of effectiveness of clinical

pharmacist’s intervention on smoking cessation program

is analyzed.


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RESULTS AND DISCUSSION

The baseline demographic characteristics of smokers and contributing factors of smoking

Table: 1 Subject Characteristics

CHARACTERISTICS MEAN(TEST) MEAN(CONTROL)

Age (years) 55.5(18-73) 48.725(18-73)

Onset of smoking(years) 22.45(9-35) 21.525(9-35)

Number of Cigarettes smoked per day 17.35(4-80) 18.325(4-80)

Pack years 24.44(0.9-140) 24.17(0.9-140)

Number of Years smoked 26.45(2-56) 29.65(2-56)

FTND scores 6(0-10) 4.525(0-10)

Number of previous quit attempts 1(0-12) 1(0-12)

Subjects in the test group and control group came from a

mean age of 55.5 and 48.725 respectively. The mean age

of onset of smoking was 22.45 in the test group and

21.525 in the control group. The mean of cigarette

smoked per day was 17.35 in test group and 18.325 in

control group. The mean pack years of smoking in test

and control were 24.44 and 24.17 respectively. The mean

of years being a smoker was 26.45 in test and 29.65 in

control group. The mean FTND score was 6 in test group

and 4.525 in control group. The mean value of no: of

previous quit attempts were one in both test and control.

DEMOGRAPHIC CHARACTERISTICS

Figure -1: Sex Distribution

In the study all the participants were male (100.0%) and

there were no female subjects in both control and test.

This showed the increased rate of smoking among males

in the particular area.

100.00%

0%

100.00%

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80%

100%

120%

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Figure -2: Age Distribution

The subjects in the age group above 65 were more

(45.0%) both in test and control. The mean age of subjects

was found to be 55.5 in test group and 48.725 in the

control group. Geriatrics covers the major class of

patients in pulmonology department and is more prone to

dangers of smoking due to their weak health status and

occurrence of more than one disease. The study

reinforced the need for cessation interventions in

geriatrics.

Figure -3: Occupation distribution

The occupational status for both study groups was

studied. Smokers were more in the business group

(55.0%) followed by farmers (35.0%) and transportation

(32.5%). It shows that the subjects who were more likely

to mix socially or work with smokers smoked more and

may be smoking due to the stress in their life. This study

showed similarity with the study conducted by

Pamela.R.Fung, R.N.Stella.

20.00% 20.00%

15.00%

45.00%

20.00%

17.50% 17.50%

45.00%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

20-35 36-50 51-65 above 65

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Test

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0%

10%

20%

30%

40%

5%

37.5%

0%

20%

5% 2.5%

12.5% 7.5%

5%

12.5%

25%

0.00%

10% 7.5% 5% 7.5% 5%

10%

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Figure – 4: Economic Status distribution

The middle class group was found to be more smoking

(73.8%) when compared to other groups. It was about

70% in the test and 77.5% in the control. The high class

group was high in test (20%) compared to control

(17.5%). The low class group was high in test (10%)

compared to control (5%).Majority of the subjects

collected came from middle class family followed by high

class and low class family. The study showed the

prevalence of smoking among common men. The

predominance of middle class in this study may be due to

their need to improve their cost of living by reducing the

expenses that they spend for smoking and associated

health problems.

Figure- 5: Education level distribution

In terms of education level smokers were high (37.5%) in

high school level which was equal in both test and

control followed by below high school level (32.5%),

graduate (21.3%), education after high school (8.8%). It

showed the lack of awareness of health dangers of

smoking among subjects with low education level and

reinforced the cessation intervention in this group.

0%

20%

40%

60%

80%

low class middle

class

high class

10%

70%

20% 5%

77.50%

17.50% P

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Economic Status

test

0%

20%

40%

60%

80%

100%

below

high

school

high

school

above

high

school

graduate

37.50%

5% 25%

32.50% 12.50% 17.50%

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Figure – 6: Marital status

Majority of smokers in the study group were married

(77.5%) about 85% in the test group and 70% in the

control group when compared to other groups. Majority

of subjects were from middle class family and were in the

age group above 65 years and were married. And they

might be smoking due to their increased responsibility

and stress. About 7.5% in both test and control were

found to be widowed and 22.5% in control and 7.5% in

test were found to be single.

Figure- 7: Family history of smoking

Among the subjects about 70.0% of smokers had a strong

family history of smoking which was similar in both

control and test group. This showed that significantly

higher proportion of smokers grew up in a smoking

household, especially where the father or siblings

smoked. The study showed similarity with the study

conducted by Pamela.R.Fung,R.N.Stella.

Figure- 8: Alcohol use among subjects

0%

50%

100%

married single widowed

85%

7.50% 7.50%

70%

22.50% 7.50%

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control

0%

100%

200%

With

family

history

Without

family

history

72.50% 27.50%

67.50% 32.50%

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control

test

0%

50%

100%

alcoholic non

alcoholic

67.50% 32.50%

47.50% 52.50%

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About 57.5% of the subjects were alcoholic which was

about 67.5% in the test group and about 47.5% in the

control group. The study shows that more than half of the

smokers were alcoholic which indicate that alcoholism

was common among smokers. Also men were more

likely want to smoke if they were drinking. The study

showed similarity with study conducted by Joel.A.Simon,

Timothy.P.Carmody and also with study conducted by

Jeri J.Sias and Ulysses J.Urquidi.

Figure – 9: Previous quit attempts

The analysis of previous quit attempts reveals that 36.3%

of the subjects had never attempted to quit, while 63.8%

had made 1 or more quit attempts. Those who attempted

to quit was about 60.0% in the control group and 67.5%

in the test group. Subjects who have one or more previous

quit attempts have greater chance of quitting smoking in

the future.

Figure -10: Level of nicotine dependence

Smokers with moderate nicotine dependence was high

about 50.0% in the test group and about 62.5% in the

control group followed by high nicotine dependence

which was 17.5% in the control group and 40.0% in the

test group and low nicotine dependence about 10.0% in

the test group and 20.0% in the control group. This

classification divided smokers as chronic, moderate and

light for the purpose of providing more attention to

groups of high nicotine dependence when compared to

other groups.

60.00%

40.00%

67.50%

32.50%

0%

20%

40%

60%

80%

Attempted quit Not attempted to quit

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Test

Control

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40%

60%

80%

low moderate high

level of nicotine dependance

10.00%

50.00% 40.00%

20.00%

62.50%

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Figure -11: Subjects with co- morbidities

Among the smokers in the study about 22.0% of the

subjects had COPD which is about 17.5% in the test and

27.5% in the control, 52.5% suffered from asthma which

is about 57.5% in the test and 47.5% in the control,

58.75% suffered from cardiovascular diseases which is

about 62.5% in the test and 55.0% in the control and

16.25% suffered from other diseases which is about

20.0% in the test and 12.5% in the control. Other diseases

included diabetes, infectious diseases etc. As expected

there was high prevalence of respiratory disorders in the

study group and this contribute to the worsening and

progression of the disease. The study also confirms that

smoking is a major factor for CVD. The study showed

similarity with the study conducted by

Pamela.R.Fung,R.N.Stella.

Smoking history and dependence

On average participants reported that they started

smoking at the age group of 15-25. The average number

of cigarettes smoked per day was 15 cigarettes.

Fagerstrom responses showed that nearly 48.8% of

participants smoked within 30 minutes of waking. The

most important reasons to quit smoking were for personal

health (77%). Over 70% were exposed to smoke from

other smokers in their homes. The study showed

similarity with the study conducted by Jeri J.Sias,Ulysses,

J.Urquidi.

Figure- 12: Distribution of number of cigars consumed per day among the study groups

The analysis of average consumption of cigarettes

smoked per day showed that in test about 45.0% and

about 52.5% in the control group smoked about 10-15

cigars per day followed by 42.5% in the test and 40.0% in

the control consumed about 15-20 cigars per day and 5-10

cigars per day was consumed by 7.5% in both test and

control. More than 20 cigars were consumed by 5.0% in

the test group and none in control group.

0.00%

20.00%

40.00%

60.00%

80.00%

COPD asthma CVD others

17.5%

57.5% 62.5%

20% 27.5%

47.5% 55%

12.5%

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testco…

0% 7.5%

45% 42.5%

5% 0%

7.5%

52.5%

40%

0% 0%

10%

20%

30%

40%

50%

60%

0 to 5 5 to 10 10 to 15 15to 20 20+

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Table :2 Reason to start smoking

REASONS TEST (%) CONTROL (%)

Stress, Fun 0% 2.5%

Family circumstances 7.5% 0%

Familycircumstances, Friend’s influence 10.0% 7.5%

Family circumstances, Fun 0% 2.5%

Friend’s influence 25% 7.5%

Friend’s influence, Fun 10% 25%

Fun 10% 0%

Subjects were asked about the reasons to start smoking

and they responded differently and showed that friend’s

influence and fun contributed more which is about 10% in

test and 25% in control. In the test group about 25%

reported friend’s influence alone as reason to start

smoking. This was followed by family circumstances and

friend’s influence which is about 10.0% in the test and

7.5% in control group. About 2.5% in test group reported

stress as the reason. Reason to start smoking should be

analyzed among smokers and is an important parameter

which can be used as a tool to eradicate smoking among

future generation by creating awareness.

B. ANALYSIS OF THE EFFECTIVENESS OF

CLINICAL PHARMACIST’S INTERVENTION

The study shows that among the current smokers who

received intensive advice to quit smoking by clinical

pharmacist was associated with an increase in quit

attempts and readiness to quit in next 3 months.

Table : 3 Follow up questionnaire

First follow up

In the test group about 97.5% of subjects and in control

group about 100.0% of subjects attended the first follow

up. One subject was lost for follow up in test group

because of death of the subject. About 57.5% of subjects

in test group and 30.0% of subjects in control group had

gained weight. This shows the evidence of weight gain

among subjects who quit smoking. Subjects who reduced

the number of cigarettes smoked were more in the test

group (77.5%) than in the control group (47.5%) which

showed positive impact of involvement of clinical

pharmacist. Subjects who used other tobacco products

were 20.0% in both test group and control group. In the

test group about 72.5% of subjects and in control group

about 69.5% showed compliance to NRT and Bupropion.

Subjects who experienced withdrawal symptoms were

97.5% in test and 97.4% in the control group. The

compliance to bupropion was an added advantage for

SL

NO

FOLLOW

UP QUESTIONNAIRE

1ST

FOLLOW UP 2ND

FOLLOW UP

Test (40)

(n,%)

Control(40)

(n,%)

Test(40)

(n,%)

Control(40)

(n,%)

yes no yes No yes no yes No

1 Success of follow up 39

97.5%

1

2.5%

40

100%

0

0%

39

97.5%

1

2.5%

40

100%

0

0%

2. Subjects who gained weight 23

57.5%

16

40%

12

30%

28

70%

29

72.5%

10

25%

17

42.5%

23

57.5%

3. Subjects who used other tobacco

products

8

20%

31

77.7%

8

20%

32

79.5%

8

20%

31

77.7%

5

12.5%

35

87.5%

4. Subject’s compliance to NRT and

Bupropion

29

72.5%

10

25%

27

69.2%

13

32.5%

29

72.5%

10

25.0%

9

23.1%

30

76.9%

5. Subjects who experienced withdrawal

symptoms

39

97.5%

0

0%

38

97.4%

2

2.6%

39

97.5%

0

0%

31

77.5%

9

22.5%


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smoking cessation because it reduced the withdrawal

symptom, depressed mood among the subjects.

Second follow up

All the subjects in the test and control (100%) attended

second follow up. About 72.5% of subjects in test group

and 42.5% of subjects in control group had gained weight.

Subjects who reduced the number of cigarettes smoked

were 85.0% in the test group and 52.5% in the control

group. The percentage shows that more number of

smokers in the test group reduced cigarette number

consumed when compared to the first follow up. Subjects

who used other tobacco products were 20.0% in test

group and 12.5% in control group. In the test group about

72.5% of subjects and in control group about 23.1%

showed compliance to NRT. The subjects who showed

compliance were more in the test than control because

they were instructed in deep about the proper use of the

nicotine gum and Bupropion. Subjects who experienced

withdrawal symptoms were 97.5% in test and 77.5% in

the control group.

Quit rates

Figure -13: Total quit rates

The quit rates among the subjects showed that 60.0%

continue to abstain from smoking in the test and 27.5% in

the control group at the end of third month of the study.

The study shows that a brief survey questionnaire that

assess smoking habit and intent to quit and provides

prompts for cessation advice can lead to increased rates of

smoking cessation advice and patient smoking cessation

compared with no intervention. The study found that a

hospital initiated smoking cessation intervention with

intensive counseling and nicotine therapy increased

smoking quit rates compared with a hospital initiated

minimal/no counseling with nicotine therapy. The study

showed similarity with the study conducted by

Joel.A.Simon and Timothy P.Carmody.

Figure -14: Quit rate in first follow up

In the first month follow up conducted for the 39 subjects

in the test group, 30.0% and in the control group about

27.5% had abstained from smoking. This showed the

influence of intensive counseling to quit smoking and

awareness made in them about the need for follow up.

60.00%

27.50%

Total quit rates

test

control

25.00%

30.00%

test control

30.00% 27.50%

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Figure -15: Quit rate in second follow up

In the second month follow up conducted for the 39

subjects in the test group another 30.0% had abstained

from smoking which showed the impact of counseling

after first follow up and NRT therapy among smokers. In

the control group none of the subjects abstained from

smoking. Most of the subjects in the control group were

followed up through telephone because of their absence in

the clinic for second follow up. Since they have got

minimal advice about the importance of follow up and

were least bothered to attend second follow up. The

majority of the subjects in test came for second follow up

and rest of them were contacted through telephone.

Table: 4 Distribution of smokers based on intensity of smoking

Study Group Distribution of smokers

Light Moderate High

Test 4

10.0%

21

50.0%

15

40.0%

Control 8

20.0%

26

62.5%

7

17.5%

Total 11

15.0%

43

56.3%

21

18.8%

The classification which divided smokers as chronic,

moderate and light was done for the purpose of providing

more attention to groups of high nicotine dependence

when compared to other groups. Chronic and moderate

smokers represent the majority of the study group and

were associated with disorders of any kind due to

smoking. Light smokers accounted the least in both the

population.

Figure – 16: Quit rates among different class of smokers

0%

20%

40%

test control

30.00%

0% P

erc

en

tage

Quit rate in second follow up

68.75%

28.5%

Quit rates among chronic smokers

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Among the chronic smokers about 28.5% in the control

group and 68.75% in test group quit smoking. Chronic

smokers are a challenge to the counseling pharmacist

because they are highly dependent on nicotine and need

special attention, intensive counseling and close follow

up. The identified chronic smokers in the test group were

followed up more frequently rather than waiting for first

and second follow up. The close follow up made the task

easier and helped to quit smoking in the second follow up

which was significantly more in the test group when

compared to control group.

Figure -17: Quit rates among moderate smokers

Quit rate in moderate smokers showed that 45% of the

test group and 28% of the control group quit smoking.

This revealed the effectiveness of involvement of clinical

pharmacist. They were not closely followed as chronic

smokers but were strongly advised for follow up visits

and were given intensive counseling.

Figure -18: Quit rates among light smokers

Among the light smokers about 25.0% in the control

group and 100.0% in the test group quit smoking. This

showed how much effective was the counseling among

light smokers.

Figure -19: Effect of Investigational Reports in Counseling

0%

50%

test control

45.00%

28.00%

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Quit rate

Quit rates among moderate smokers

100.00%

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0%

100%

200%

test control

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In the test group more than half of the subjects were

counseled with the support of investigational reports such

as abnormal lung age and rest of the subjects were given

general counseling. The result shows that about 52.38%

of the subjects given general counseling and about

68.40% of the subjects given counseling with

investigational reports quit smoking for the three month

study. Lung age is an important parameter in PFT which

was very much useful for the counseling session. Only the

lung age of the subjects who were willing to perform PFT

was calculated. In the control group subjects who were

subjected to PFT, lung age were not calculated. The study

shows that the presence of any co-existing lung condition

and explanation of the condition with investigational

reports like abnormal lung age was associated with

greater absistence rate. The study showed similarity with

the study conducted by Pamela R. Fung21

.

Percentage of Smokers Who Reduced Cigarette Number:

Figure -20: Smokers who reduced cigarette number

In the study about 62.5% of subjects in the test group and

27.58% in the control group had reduced their cigarette

consumption. Individuals who fully comply with

treatment and those who had strong willpower were able

to able to quit smoking and reduce the number of

cigarettes smoked. The smokers who reduced cigarette

numbers had a great chance of quitting smoking

completely in the future.

Percentage of awareness among smokers

Figure -21: Awareness of health dangers of smoking among subjects

62.50%

27.58%

Subjects who reduced cigar number

test

control

0% 2.50% 5.00%

22.50%

70.00%

17.50%

60.00%

12.50%

1.00% 0%

10%

20%

30%

40%

50%

60%

70%

80%

totally

disagree

disagree don’t

know

agree totally

agree

Awareness of health dangers of smoking among smokers

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The percentage of awareness of health dangers of

smoking were high in test group after the counseling

session when compared to control group who did not

attended the counseling session. About 70.0% in the test

totally agreed to the facts in the questionnaire after the

counseling session. Increased awareness rate about

different harms which smoking can create to the body

among the subjects was a factor predictive of high

absistence rate from smoking. The counseling session had

helped a lot to create awareness about the dangers of

smoking among the subjects in the test group.

Interestingly, the study revealed that very little

relationship between the absistence rate and the use of

quitting aids such as NRT. Possible reasons may include

varying adherence to the use of NRT when prescribed.

Furthermore NRT may have been preferentially used by

those with higher nicotine dependence. The study showed

similarity with the study conducted by Pamela R.Fung.

RESULT OF THE SURVEY CONDUCTED BY

ADMINISTERING A QUESTIONNAIRE

AMONG THE TEST GROUP TO EVALUATE

THE EFFECTIVENESS OF COUNSELING

The survey questionnaire was analyzed for the percentage

of patients responded for yes or no questions and showed

that

Table: 5 Survey Questionnaire

SL

NO

QUESTIONS YES

(n&%)

NO

(n&%)

1 Have you ever visited a smoking cessation clinic before? 7,

15.3%

33,

84.61%

2 If yes, whether there was the involvement of a clinical pharmacist? 0,

0%

39,

100%

3 Do you feel a pharmacist as more accessible than a physician? 31,

79.48%

8,

20.51%

4 Do you feel the interaction with a pharmacist more convenient than a physician? 32,

87.1%

5,

12.8%

5 Did you feel the tips as helpful to quit smoking/reduce the cigarette number smoked? 29,

74.35%

11,

25.64%

6 Did you feel the booklet helped you to know about the dangers of smoking? 39,

100%

0,

0%

7 Did you feel the directions given by the pharmacist for the proper usage of NRT as

more useful?

33,

89.7%

4,

10.25%

8 Do you feel the location of counseling session was accessible and comfortable? 25,

64.10%

15,

38.46%

9 Do you feel counseling as an added advantage to quit smoking/reduce the no: of

cigarettes smoked?

30,

76.92%

9,

23.07%

10 Will you recommend our counseling services to a friend? 35,

94.8%

2,

5.12%

The questionnaire was distributed among the 39 subjects

who attended the second follow up. The result point out

that about 15.3% of the subjects have visited a smoking

cessation clinic before and there was not any involvement

of a clinical pharmacist in those clinics. About 79.48%

and 87.1% in the group felt pharmacist as more accessible

and interaction with a pharmacist more convenient than a

physician. In the study about 74.35% felt that the quit

smoking tips used during the counseling session as useful

to help them quit smoking/reduce the number of cigarettes

smoked. The entire subject group felt booklet was an asset

to gain knowledge about the health dangers of smoking.

About 89.7% of subjects felt the directions for the proper

usage of NRT given by the clinical pharmacist as more

useful. Only 64.5% of the subjects felt the location of

counseling session as more accessible and comfortable.

For 76.4% of the subjects counseling was an added

advantage to quit smoking/reduce the number of


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cigarettes smoked. In the study 94.8% reported that they

will recommend the counseling services to their friends

who needed the service.

From the analysis of follow up questionnaire also it was

revealed that 77.5% in the test group self-reported that

they felt pharmacist helped them to quit smoking or

reducing the number of cigarettes smoked. The study

showed similarity to the study conducted by Karen

SuchanekHudmon, Alexander V.Prokhorov.

Finally, all the results point out the need of a smoking

cessation clinic in an accessible site inside the hospital

and also recommend the active participation of a specially

trained clinical pharmacist. Also subjects responded that

they will recommend smokers they knew to the clinic. It

will become an opportunity to make a tobacco free

environment and thereby ensure the improvement of

public health.

The analysis of the baseline demographics shows the

absence of female gender in both groups which may be

due to the characteristic culture of the geographic area of

the study. The majority of the study population comprised

of smokers with age group above 65 years. Geriatrics is

more prone to dangers of smoking due to their weak

health status and always presented with more than one

disease. Increased number of chronic smokers in the study

indicated the need of high attention for the particular

group. Most of the smokers were married, had only high

school education and were from a middle class family

with a positive family history of smoking. Family

background is a prominent factor that promotes smoking.

Majority of the smokers had occupational status as

business. My study also indicated that majority of

smokers showed with respiratory and cardiovascular

disorders. This reflects the ill effects of smoking. The

reason to start smoking reported by the smokers were

friend’s inspiration, fun, to relieve stress etc.

The study concluded that majority of smokers were able

to quit due to intensive counseling by a clinical

pharmacist. Unlike most other clinicians, pharmacists are

easily approachable for the public and advice from them

does not require an appointment. As such pharmacist have

the opportunity to reach and assist underserved

populations. Because identifying tobacco users is a crucial

step in the treatment of tobacco use and dependence,

systemic changes in the pharmacy practice environment

are necessary if pharmacists are to assume a more

significant role in the provision of cessation services. For

example, routine use of pharmacy computer system

software to document smoking status could screen for

potential smoking-medication interactions and serve as a

prompt for the pharmacist to engage in cessation

activities. Since training increase cessation counseling

interventions efforts should be made to provide

comprehensive, evidence based training to practice

pharmacist through continuing education programs and to

students through required pharmacy school work.

CONCLUSION

The study evaluated the effectiveness of a hospital

initiated smoking cessation intervention by a clinical

pharmacist that included 3 months of follow up and also

analyzed the baseline demographics of smokers. The

pharmacist-managed Smoking Cessation program

successfully aided approximately more than half its

participants to quit smoking at 1 and 3 months. Although

higher attendance rates increase cessation rates, steps

could be taken in order to effectively maximize the

pharmacist’s time and minimize patient commitment,

while also achieving the best patient outcomes. The most

common reasons for quitting smoking were a concern

with the current health status and a concern with the

future health status.

Smoking cessation for current smokers is a healthcare

imperative. We hypothesized that a hospital based

smoking cessation program involving intensive

counseling by a clinical pharmacist and support along

with nicotine replacement therapy would provide an

effective intervention for smoking cessation.

In summary the results of this prospective study indicates

that hospital based smoking cessation with the active

participation of clinical pharmacist is very effective. Both

social and psychological factors are associated with a

greater chance of insistence. Intensive counseling with

appropriate pharmacotherapy is feasible in the hospital

setting and should be offered to all patients who are

current smokers.

Recommendations

Since hospitalized smokers present with high levels of

nicotine dependence, high tobacco intake, early age at

smoking initiation, and high number of cigarettes smoked

per day, they require a systematized approach to smoking

cessation during hospitalization in order to guarantee

successful smoking cessation. In order to optimize such

an approach, a comprehensive program should be

developed in the institution, focusing on the following:


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• training physicians, nurses, and other health care

workers who have close contact with patients

• providing medication to assist in smoking cessation

• implementing strategies aimed at smokers, with

special attention to hospitalized smokers

• Such a program should continue after discharge.

• Special smoking cessation clinic set for the purpose

and active participation of a clinical pharmacist to

run the clinic.

• Make use of specially trained clinical pharmacist in

de-addiction clinics in the hospital. This may be

helpful in the unchallenging service of a clinical

pharmacist and also can save the valuable time of the

physician.

• Should implement the guidelines for smoking

cessation in the hospital and update it periodically.

• World No Tobacco Day should be celebrated every

year with collabaration of hospital and community

pharmacist to make the public aware about the

dangers of tobacco use, the business practices of

tobacco companies, what WHO is doing to fight the

tobacco epidemic and what people can do to claim

their right to health and healthy living and to protect

future generations.

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Effectiveness of clinical pharmacist intervention on smoking secession

Health & Medicine

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